• Etiology
  • Usually post surgical (urethral diverticulectomy, anti-incontinence surgery, etc.)
  • Other:
    • Trauma
    • LUT instrumentation (catheterization)
    • Radiation
    • Child birth/obstetrical
• Presentation
  • Often asymptomatic if located in the distal third of the urethra
  • If symptoms present then the presentation is similar to VVF
  • May present with symptoms suggestive of stress or urgency incontinence
    • In these cases cystourethrography will be necessary to make the diagnosis.
  • Dyspareunia
  • Recurrent urinary tract infections (UTls).
• Evaluation
  • Voiding cystourethrography VCUG.
    • Voiding images must be obtained in patients with a competent bladder neck and proximal sphincteric mechanism or the fistula will not be demonstrated
  • Cystoscopy.
    • Useful to evaluate for concurrent abnormalities of the bladder and urethra.
• Therapy
  • Catheter drainage
    • Useful in a limited number of cases if the fistula is noted promptly.
  • Transvaginal surgical excision

References

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